Individual
MRS. NICOLE FABICO VALES-BUCKWALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
5301 BROADWAY, WEST NEW YORK, NJ 07093-2622
(201) 866-9320
(201) 866-7588
Mailing address
12 MATTBEN DR, WARREN, NJ 07059-7142
(908) 420-0528
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
26NN08808600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26NN08808600
NJ APRN LICENSE
NJ
Enumeration date
04/03/2008
Last updated
02/04/2019
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